The main objective of this dissertation was to evaluate the effectiveness of inpatient rehabilitation facilities (IRF) compared to other post-acute care (PAC) alternatives in reducing functional disability for total hip replacement (THR) patients. A secondary objective of this dissertation was to pilot investigate if the posterior and the anterior surgical approaches were associated with different functional disability in patients with same PAC placement. A 10% random sample of 1994-1995 Medicare THR patients, representative of the 12 states with the highest THR volume was inducted into this study. A heterogeneous treatment effects model, utilizing selectivity-corrected tobit regression, was used to estimate the effect of PAC on functional outcomes. Patients were identified and surveyed postoperatively and subsequently followed for one year. Survey data were linked to claims and chart abstraction data. Of the 749 THR patients, 87 had IRF care, 168 had SNF care, 247 had formal home care and 257 had informal home care. The 4 groups differed on important baseline variables. After adjusting for selection, formal home care was associated with significantly lower functional disability compared to informal home care at follow-up; however, IRF care and SNF care were not better than informal care. In addition, the posterior surgical approach was not associated with different functional outcomes compared to the lateral approach in patients with same PAC placement. In conclusion, because IRF care for THR patients did not lead to better functional outcomes than informal home care, the 75% rule may be justified in excluding THR. Formal home care is a potentially cheaper and more effective substitute, but may not suit every THR patient. Further research is needed to understand the effective components of each PAC modality.... and functional status in figure 3. Figure 3: Schematic Diagram to illustrate
Selectivity correction XI² This figure is a simplification of the conceptual
framework. 70.